Triage: Dr. James Orbinski's Humanitarian Dilemma, 88 minutes, 2007, Canada
Directed by Patrick Reed
National Film Board of Canada
White Pine Pictures

Dr. James Orbinski lays a moral dilemma in our laps: how does one maintain clarity of mind and objective detachment when one must make a "Sophie’s Choice"  a hundred times a day, a choice of who will receive medical treatment and who will be allowed to die?

What would be but a mere intellectual exercise in a university philosophy ethics class becomes the existential downside of the necessary triage procedure in a makeshift medical treatment centre in Kigali, Rwanda in 1994. Dr. James Orbinski, a member of Médecins Sans Frontières (aka Doctors Without Borders), was called upon to classify the patients at arrival: who would be given immediate medical treatment, who would be asked to wait, and who would be judged as dying and would receive only solace and comfort.

The Rwandan genocide of 800,000 Tutsi tribes people in a short space of a hundred days by a Hutu minority, mostly by machete attacks, was ignored by the international community. The United States declined to send aid, despite warnings by their own intelligence sources of impending mass slaughter. The United Nations' small peacekeeping force, headed by Canada’s General Roméo Dallaire in Kigali, was forced to do what it could without world aid. Against a backdrop of international indifference, physicians with Médecins Sans Frontières did what they could. Orbinski was there.  He was there in Kigali, Somalia, and he was in Goma, Congo. "Triage: Dr. James Orbinski’s Humanitarian Dilemma" is his story.

"Triage" opens in Kigali, Rwanda. Orbinski talks of placing tape on patients’ foreheads, with the numbers written: one, two or three. He says that the “irretrievables,” the threes,  can only be made comfortable. Doing triage is a moral decision, but his moral outrage is reserved for the situation and for the indifference that led up to his having to make triage a moral decision.

What we do with our rage is another dilemma. What are we to do when faced with thousands upon thousands of people who are dying literally of indifference, an indifference created by wrong-headed or plainly incompetent political decisions?

The film shifts from Rwanda to Orbinski’s meeting old friends from 1993 in Somalia, the first place he went with Médecins Sans Frontières. He meets Lesto, who Orbinski saved from certain death by armed thugs through the simple expedient of buying his life for five hundred dollars. Reminiscing with Lesto on a speeding truck through the countryside with imminent threat of ambush at every corner or set of potholes, Orbinski says of this outlaw land, “There’s no fast lane for the ambulance – you have to create it yourself.” They were often fired upon.

Heedful of the danger of the countryside outside the compound in Baidoa, Somalia, Orbinski casually refers to it in conversation as “the Abyss.” Nietzsche’s admonition comes to mind here: Battle not with monsters, lest ye become a monster, and if you gaze into the abyss, the abyss gazes also into you.” Little wonder that transformation has its hazards and its price.

Of the compound, Orbinski describes what it’s like to experience a multitude of starving and dying refugees, “The Silence. There’s 150,000 people silently waiting for food. That’s what I remember the most. The silence. Too weak to even assert themselves – that’s what a feeding centre looks like.”

Orbinski observes that famines are almost always man-made. A 1993 US-backed humanitarian mission to Somalia lost eighteen soldiers when a military Blackhawk helicopter was shot down. The US abruptly withdrew. Other international missions in Somalia left soon after, leaving it virtually in anarchy and chaos.

Orbinski lost his friend Dr. Ricardo in 1997, murdered while working at a country hospital in Somalia. He ruefully observes that it could have been him.

“You create death by not acting,” Orbinski angrily mutters as he visits a refugee camp in Baidoa, virtually unchanged through international indifference, in its thousands of makeshift tattered tents from fifteen years ago. Thousands of people have been left hanging for those fifteen years, with no resolution in sight.

There is good news in Baidoa, however. Orbinski visits an orphanage where 300 students are housed and schooled. The orphanage director proudly exclaims, “They are our seeds for tomorrow’s Somalia. They are not going to walk away, they are not going to turn their backs on their own people.”

Speaking of the 800,000 people killed in a hundred days, Orbinski says of his work with Médecins Sans Frontières in Rwanda, “This wasn’t a medical safari ... it was a fucking genocide.” Wild dogs would come to the periphery of the Red Cross Hospital in Kigali at night to eat on the corpses. In addition to the usual battlefield injuries encountered in a field hospital, they had to deal with the large number of gruesome wounds caused by machetes, the weapon of choice of the Hutu genocidaires.

One Rwandan survivor takes Orbinski to a hut where exhumed bodies, preserved in lye, await the visitor. He explains he has been digging up the bodies and treating them with lye in order that the whole world will know what happened in those hundred days.

Director Patrick Reed ("Shake Hands with the Devil: The Journey of Roméo Dallaire," and "Tsepong: A Clinic Called Hope") and producer Peter Raymont  worked with White Pine Pictures and the National Film Board of Canada to bring Orbinski’s experiences in Rwanda and Somalia to the screen, receiving the 2008 Deborah Fletcher Award of Excellence in Filmmaking on International Development.

Orbinski speaks of a personal transformation, “My transformation is not purely based on my work.”
It is a change his parents noticed when he returned home to Canada for a visit shortly after his field experiences. His father told him, “You can’t just lie down in the snow. You’ve got to get up.” Eventually, Orbinski found an outlet for his grief – writing the book "An Imperfect Offering: Humanitarian Action in the Twenty-first century" (2008).

Médecins Sans Frontières was awarded the Nobel Peace Prize in 1999, and as its president, Orbinski accepted the prize in the award ceremony in Oslo, Norway.

“Feelings are absolutely vital to us as human beings," Orbinski says, "but it does not stop there.” He calls for humanitarianism beyond compassion – as a citizen, each one of us has a responsibility to address the causes that made for the humanitarian crisis under consideration.

He has made a measure of peace with himself, saying, “I’ve struggled to live my life the right way as I saw it, that respects the dignity of others, even that of our enemies. This is the lens by which we should see the world.”

"Triage" is a difficult film to watch. What it documents is hard to believe. But you must believe.

Dr. James Jude Orbinski is currently Associate Professor of Medicine at the University of Toronto, and a Fellow at the Munk Centre for International Studies. He is a co-founder and Chair of the Board of Directors of Dignitas International, an organization devoted to providing access to treatment for HIV/AIDS.

Music in "Triage" includes songs by K’naan, a Somali-Canadian poet and musician, and  by The Mighty Popo, a Rwandan/Burundian refugee currently living in Canada.

©Photo by Lois Siegel
The Mighty Popo

Postscript:  A higher military court in the Rwandan capital Kigali has upheld the life sentence of Major General Laurent Munyakazi for crimes against humanity and conspiracy to commit mass murders during the 100-day 1994 Rwandan genocide.

On December 18, 2008,  a United Nations court sentenced Theoneste Bagosora to life in prison for masterminding the slaughter of 800,000 people in Rwanda in 1994. “Colonel Bagosora is guilty of genocide and crimes against humanity and war crimes,” the court said.

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